Provider Demographics
NPI:1437250941
Name:ALLEY, PAMELA SUE
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:ALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 WASHINGTON AVENUE
Mailing Address - Street 2:VISION OF HEALTH
Mailing Address - City:BALDWIN
Mailing Address - State:MI
Mailing Address - Zip Code:49304
Mailing Address - Country:US
Mailing Address - Phone:231-745-4914
Mailing Address - Fax:
Practice Address - Street 1:1234 WASHINGTON AVE
Practice Address - Street 2:VISION OF HEALTH
Practice Address - City:BALDWIN
Practice Address - State:MI
Practice Address - Zip Code:49304
Practice Address - Country:US
Practice Address - Phone:231-832-3930
Practice Address - Fax:231-882-2456
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704186397363LA2200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily